The Introduction of Endovenous Treatment for Varicose Veins in Japan

Abstract

This article describes my experience over 20 years from the introduction of endovenous treatment for varicose veins in Japan. We started with ambulatory high ligation and stripping under tumescent local anesthesia after ultrasound diagnosis in 2000. Based on this experience, we introduced endovenous laser ablation (EVLA) in 2002. Initially, EVLA often resulted in pain, bruising, and recanalization of the treated vein. EVLA using a 1470 nm laser and radial fiber resulted in a better occlusion rate, less postoperative pain and less bruising than EVLA with an 810 nm laser. Various types of endovenous treatment devices have been used after the health insurance coverage of EVLA in 2011, and the VenaSeal closure system was approved in 2019. The guideline committee of Japanese society of phlebology, established in 2017, revised the clinical practice guidelines for endovenous thermal ablation for varicose veins in 2019 and has been vigorously working to eradicate overuse of endovenous treatment for the wrong indication. Currently, endovenous treatment is the standard and is used in 90% of surgical treatments for varicose veins.